Healthcare Provider Details

I. General information

NPI: 1003008780
Provider Name (Legal Business Name): MAJA KATARINA BERGMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 146TH ST APT 52
NEW YORK NY
10031-0708
US

IV. Provider business mailing address

600 W 146TH ST APT 52
NEW YORK NY
10031-0708
US

V. Phone/Fax

Practice location:
  • Phone: 917-723-0619
  • Fax: 510-601-4002
Mailing address:
  • Phone: 917-723-0619
  • Fax: 510-601-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number026159
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: